| NPI | 1902143225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL-11653) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207190) |
| 225100000X Physical Therapist (Licence: CO PTL.0011653) | |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2020-12-23 |